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Why we don’t usually give emergent radiation therapy

Conditions and Diseases

July 29, 2014

The first lecture in a radiation oncology residency program is “Radiation Oncology Emergencies,” to educate the new residents how to manage inpatient consultations and emergencies. While preparing my lecture this year, it occurred to me how useful this basic information would be to the physicians calling for the consultation. Sharing our thought process in triaging patient explains why we don’t rush to utilize radiation, even in cases of a cord …

Rethinking the fix-it model in medicine

Gretchen Schwarze, MD

Physician

July 28, 2014

She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year …

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Rethinking the fix-it model in medicine

Doctors are helpers, not healers

Rob Lamberts, MD

Physician

July 28, 2014

It’s a seductive idea. We doctors possess knowledge and experience which can not only help people, but can save their lives. We get opportunities to be the right person at the right time to offer the right help that makes all of the difference. It’s one of the greatest things about our profession. It’s also one of its greatest traps.

I’ve heard many doctors refer to themselves as “healers,” as if …

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Doctors are helpers, not healers

Doctors today: Young, broke and human

Aunna Pourang, MD

Physician

July 28, 2014

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“Oh, you’re my doctor? A woman?”

Who do you picture walking through the exam room door at your new doctor’s office? Is it the Norman Rockwell depiction of an older, jolly looking male? After residency, I was alarmed at how many patients commented on my age and gender:

“How old are you, 12?” or, “Oh, you’re my doctor? A woman?”

This got me thinking about …

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Doctors today: Young, broke and human

Why Republicans should worry about the Halbig ruling

Robert Laszewski

Health Policy

July 28, 2014

The 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law.

The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do …

Mainstream media highlights the MOC debate: What did they get wrong?

Wes Fisher, MD

Physician

July 28, 2014

Recently, the American Board of Medical Specialties’ (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled “Skill Reviews Upset Doctors.”

While it is certainly nice to see an article reaching the main stream media concerning doctors’ concerns with the MOC program, the issue with the MOC debate is not that doctors are upset. The real issue is …

How to survive your first year of medical school

Jason Spears

Medical Education

July 28, 2014

Let me begin with by extending a hearty congratulation on matriculating to medical school. The pre-med years were tough with organic chemistry, staying involved with leadership activities, chasing down the elusive letter of recommendation, and sitting for the MCAT.

But you did it.

Be proud of what you’ve accomplished because you’re one step closer to becoming a doctor.

You may have fears, concerns or misgivings about what is coming your way and this …

Blue collar concierge medicine is for everyone

Stephen C. Schimpff, MD

Physician

July 28, 2014

Part of a series.

Is concierge medicine for everyone or is it just for the rich, the 1%? Most people assume it is for the elite and cannot be afforded by the common man, the masses. That is unfortunate because in many cases it can be quite affordable. Here are three examples.

AtlasMD in Kansas City and others like it think of themselves as “blue collar” concierge practices. According to …

An interview with Jessie Gruman

Lisa Gualtieri, PhD

Patient

July 28, 2014

gruman

Jessie Gruman, who sadly died July 14, 2014, was someone I greatly admired as a person and as a patient activist. I interviewed her in late April for research I was conducting on patient activism, and she graciously allowed me to publish the interview, wanting, not surprisingly for those who knew her, to do everything she could to use her experiences …

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An interview with Jessie Gruman

Hospice patients can use functional improvement too

Alex Smith, MD

Physician

July 27, 2014

One of the skilled nursing facilities I work with has a hospice unit. We occasionally have patients on the hospice unit who might benefit from physical therapy. The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient. If the goals are …

Contrave: A promising new approach in the fight against obesity?

David Macklin, MD

Medications

July 27, 2014

As a family physician whose practice deals exclusively in the treatment of obesity, it strikes me as remarkable how little we understand about the disease, which is Canada’s second-leading cause of preventable death.

In every region of the developed world, obesity doubled in the twenty years between 1988 and 2008, according to World Health Organization, which now count more than a half-billion of Earth’s population as obese. The Public Health Agency …

Replacing doctors with technology: Don’t knock on my door yet.

Jordan Grumet, MD

Physician

July 27, 2014

The house was getting cold. My wife and kids snuggled in their blankets as I crept out of bed and checked the thermostat. The subzero winter air howled as a blustery morning took shape outside our windows. I looked at the digital display with disbelief and manually tapped the screen with my finger, hoping that the jarring motion would loosen the exact faulty screw leading to our frigid state. …

In medicine, the patient is not always right

Trudy Lieberman

Patient

July 27, 2014

Beginning with the Institute of Medicine’s (IOM) landmark Quality Chasm report in the late 1990s, the health policy establishment, the medical profession and the American public began to hear a new and disconcerting message: American health care was not patient-centered.

The IOM prescribed a number of recommendations to redesign health care delivery, one calling for patients as the source of control over their care. “Patients should …

The effect of health care quality on hospital credit ratings

Alexandra S. Brown, MD

Health Policy

July 27, 2014

Many hospitals rely on bond funding for their expansion and the purchase of new equipment. Revenue that is created by the hospital is then used to pay back the bondholders. The risk to bondholders is that they are generally paid after the hospital pays its operational expenses. Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk.

Hospitals have historically been rated …

Why this is an exciting time to work in psychiatry

Helen M. Farrell, MD

Physician

July 27, 2014

Today, I celebrated mental health care. And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support.

I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness. The diverse stories of …

Better care is mindfully listening to patients

Davis Liu, MD

Physician

July 27, 2014

“Dr. Liu, I don’t think he has diverticulitis.”

So said the second-year medical student. She had just completed her first year of anatomy, biochemistry, pathology, and introduction to doctoring at the local medical school. One of the sharpest medical students I’ve proctored.

Like many summers, I’ve been fortunate to spend time with the next generation of doctors. These future doctors were brimmed with enthusiasm and energy. Instead of taking time off to …

Choose your career: Should I be a nurse or a doctor?

Shirie Leng, MD

Medical Education

July 26, 2014

Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine. Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless.

But people ask me all the time, so, as a little experiment, I …

Suicide Med: A medical school thriller

Freida McFadden, MD

Medical Education

July 26, 2014

An excerpt from Suicide Med.

“I wish I had become a ballet dancer instead.”

I use the back of my forearm to swipe at strands of dark hair that have come loose from the tight bun at the back of my head. The attempt fails and the escaped locks fall back …

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Suicide Med: A medical school thriller

Is higher cost health care perceived as being higher quality?

Brad Wright, PhD

Health Policy

July 26, 2014

Luxury goods are items that people purchase in disproportionately greater amounts as their income increases. That’s how economists think of them anyway. But for the average American, a luxury good means something else. We tend to think of luxury goods being things like designer clothing, luxury cars, and high-end restaurants. Our minds fill with images of Gucci, Burberry, and Luis Vuitton, or Mercedes-Benz, Porsche, and Ferrari.

One thing is clear to …

Can medical students lean in to psychiatry?

Jennifer Adaeze Anyaegbunam

Medical Education

July 26, 2014

I recently read an interesting article in Glamour about why Zosia Mamet, an actress on HBO’s Girls, refuses to “lean in.” While the column focuses on the influence of modern-day feminism on notions of professional success, her words resonated with me as a medical student and an aspiring psychiatrist.